title: Tic disorders.
abstract: OBJECTIVE
  Primary tic disorders are complex, multifactorial disorders in which tics are accompanied by other sensory features and an array of comorbid behavioral disorders. Secondary tics are proportionally much less frequent, but their etiology is diverse. This review aims to guide clinicians in the recognition of the phenomenology, pathophysiology, and treatment of these disorders.
  
  
  RESULTS
  Advances include greater phenomenologic insights, particularly of nonmotor (sensory) features; increased knowledge of disease mechanisms, particularly coming from neuropsychological, functional imaging, pathologic, and animal model studies; growing evidence on the efficacy of alpha-2 agonists and the newer generation of dopamine-modulating agents; and recent strides in the evaluation of cognitive-behavioral therapy and deep brain stimulation surgery.
  
  
  CONCLUSIONS
  The correct diagnostic approach to tic disorders requires accurate historical gathering, a thorough neurologic examination, and detailed definition of the patient's psychopathologic profile. Treatment should always begin with individualized psychoeducational strategies. Although pharmacologic treatments remain beneficial for most patients, cognitive-behavioral treatments have thus far shown promising efficacy. Deep brain stimulation surgery should still be limited to adult patients refractory to pharmacotherapy and cognitive-behavioral therapy.
authors.forename: Davide
authors.initials: D
authors.lastname: Martino
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Mink
mesh_terms: D000293:Adolescent; D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000377:Agnosia / Q000150:complications; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications; D001905:Botulinum Toxins / Q000627:therapeutic use; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D046690:Deep Brain Stimulation / Q000379:methods; D003937:Diagnosis, Differential; D018492:Dopamine Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications; D010375:Pedigree; D011613:Psychotherapy / Q000379:methods; D013981:Tic Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D018726:Anti-Dyskinesia Agents; D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D001905:Botulinum Toxins